[Ask Inna] Your Thyroid and Hashimoto’s Questions Answered

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I recently opened the door to questions about thyroid conditions and Hashimoto’s on my Instagram page. And, wow, was I flooded with really great questions. In this episode, I answer as many as I can.

The Question - How do you Shrink Your Thyroid Nodules?

This was the question I got the most from my Instagram followers. Before I answer, I want to clarify a few things. There are many different types of growths on the thyroid. Many people confuse enlargement of the thyroid with nodules or inflammation. If the thyroid is enlarged in one spot, that is a nodule. However, if the whole thyroid is enlarged it’s either a goiter or thyroiditis.

A goiter is caused by iodine deficiency (uncommon in the US), consumption of too many goitrogenic foods, or thyroiditis. This swelling is often painless (pain may indicate that inflammation is from a virus).

Goiter growth is fed by a high TSH (Thyroid Stimulating Hormone) and also by high hCG (human chorionic gonadotropin) which is present during and after pregnancy. Eventually the hCG will go back down but if the TSH level is not treated, it can continue to feed the goiter and it will continue to grow.

The first step in reducing a swollen thyroid is to get TSH levels in balance and to reduce goitrogenic foods.

As for nodules on the thyroid, these could be solid or cysts filled with fluid. About 50% of people have these and many are benign. Someone with Hashimoto’s may experience nodules during a flare up. However, it’s important to have them checked because they could lead to thyroid cancer. The good news is if the nodules are due to Hashimoto’s, addressing the root cause of Hashimoto’s can help shrink the nodules as well.

For more on this, refer to past episodes 32 - Solving the Autoimmunity Mystery, and 68 - Ask Inna: Hashimoto’s Questions.

The Question - Do people with Hashimoto’s have a compromised immune system?

This is a question that has popped up a lot more since the start of the pandemic. People want to know if having Hashimoto’s means your immune system is weakened.

Inna’s Response

This might seem logical but it’s actually the opposite. Hashimoto’s makes the immune system hyper-vigilant. The problem is that the immune system is confused so it’s extra-active. But this extra activity means that it attacks your own tissue - in this case, your thyroid. So, it’s not weak in that sense but because it’s so hyper-vigilant and attacking your tissue, it can actually weaken its response to bacteria and viruses.

The Question - My antibodies are still high. Is there something else I should look at?

This question came with quite a bit of backstory. She explained that she had switched from taking just Synthroid (a prescription synthetic thyroid hormone replacement) to adding Cytomel. However her hashimoto antibodies continue to be high despite adhering to the autoimmune protocol (AIP) diet (with the exception of eggs). She wondered if the eggs could really cause that much of an issue. An ultrasound also revealed that she has two nodules on her thyroid. So, the real question is, what’s the root cause and what else can she do?

Inna’s Response

Finding the underlying cause can be tricky. It seems like she’s already looked at the food angle by doing a mostly AIP diet. It is possible that the eggs are a trigger because every person is different but it’s hard to say. A really good food sensitivity test (like the comprehensive panel test done at Vibrant America), and find out conclusively if eggs are an issue for you.

After that, you want to make sure you look for other underlying causes like stress, infections, and toxins. Keep in mind that you want to give new medication combinations a couple of months to shift your antibody response.

The Question - My TSH levels are very erratic as is my weight gain. What are the best diet plans, supplements and essential tests?

Inna’s Response

In this case it sounds like it may be Hashimoto’s and the swings are caused by flare ups. TSH can go up and down erratically with Hashimoto’s.

For tests, you want to make sure to get a TSH a total T for the total T3 free, a T4, free T3, reverse T3 and (very importantly) both thyroid antibodies for Hashimoto’s - thyroglobulin and thyroid peroxidase.

As for the diet plan, the best one to start with is the AIP plan where you take out grains, dairy, nuts, eggs and processed foods. If this feels too restrictive at first, you can start with removing gluten and dairy. You should also look at underlying causes like infections, toxins and stress.

The Question - I’ve been diagnosed with Hashimoto’s but my tests are now normal and I don’t have any symptoms. Do I still have Hashi’s?

This Instagram follower has seen her test results move into normal range lately with TSH at 1.5 and antibodies consistently below the threshold of 35 (from 17 to 34). And, without any mood or energy symptoms it has her feeling like she’s in a gray zone.

Inna’s Response

The answer here depends on when and how the diagnosis was made. Look back at your blood work and see that original test that led to a diagnosis. Were your antibodies actually high at the time? Or, did your diagnosis come from an ultrasound? Some practitioners assume Hashimoto’s when they see nodules which is not always an indication of Hashimoto’s. This can lead to a misdiagnosis.

If the diagnosis was correct, antibodies in the normal range does not mean that your Hashimoto’s is cured per say because technically once the autoimmune is there, it will be there, but it would mean that it’s in remission and what you are doing is working so keep up the good work.

The Question - What could cause T4 to convert to reverse T3?

This question is a bit complicated for anyone not familiar with how the thyroid works, but essentially T4 normally converts to T3 but in this case, it’s converting to reverse T3.

Inna’s Response

The biggest thing here is stress and inflammation. Stress can come from emotional stress (our thoughts). It can also be physical, for example if you have any type of underlying infection (like Epstein-Barr Virus, Candida, or a parasite). Another possible cause might be food or toxins.

You want to find that root cause but while you’re investigating, I do find taking Phosphatidylserine is helpful. I use PS 150 from Designs for Health which is a soy-free formula. It helps bring down cortisol and lowers reverse T3. I usually suggest people take two capsules around bedtime.

The Question - How can I lower my TPO (Thyroid peroxidase)?

There was a lot more to this question, so I wanted to share exactly what she wrote, “I have Hashi's. My naturopath has patiently and skillfully supported my thyroid, and other hormones, over the past two years to the point where I haven't needed any T4 or T3 for months (steady labs)! Yet, my system is so reactive, daily. I feel like I'm on the edge of hypo/hyper symptoms. And my TPO is still 75-100...? Is there anything I can do to help lower it? I'm on a dialed-in, wholefoods diet (lots of intolerances).

Inna’s Response

Looking at diet is definitely key here. You mentioned that your naturopath supported your thyroid and your hormones but have...